Facial nerve palsy: Surgical treatment

A review of the surgical treatment for facial nerve palsy is presented. The facial nerve can be damaged during surgery at the cerebellopontine angle, petrous bone, and parotid areas. Facial nerve palsy due to traumatic or infective-inflammatory causes is less frequent. Electromyelography and computerized tomography scans are useful diagnostic tools. Intraoperative electrophysiologic monitoring is important to preserve the anatomic integrity of the facial nerve. Intraoperative injuries of the facial nerve can be repaired immediately by direct approximation of the nerve stumps or by nerve graft interposition. The nerve stumps can be fixed using 10-0 nylon sutures or fibrin glue or both. When the central stump of the facial nerve is lost, a second operation using a donor nerve (e.g., the hypoglossus) should be performed as early as possible (weeks), and in any case within 6 months, but not later than 12 months. Inveterated facial nerve palsy may be treated using muscle transfers and other procedures for palpebral function recovery and prevention of corneal damage. Recent facial nerve palsy may be treated with excellent functional results; inveterated facial nerve palsy may improve with palliative procedures.